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耳鸣:脑表面刺激的治疗应用

Tinnitus: therapeutic use of superficial brain stimulation.

作者信息

Langguth Berthold, De Ridder Dirk

机构信息

Interdisciplinary Tinnitus Clinic, Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.

出版信息

Handb Clin Neurol. 2013;116:441-67. doi: 10.1016/B978-0-444-53497-2.00036-X.


DOI:10.1016/B978-0-444-53497-2.00036-X
PMID:24112915
Abstract

Tinnitus is a common disorder and traditional treatment approaches such as medication, active or passive sound enhancement, and cognitive behavioral therapy have limited efficacy. Thus, there is an urgent need for more effective treatment approaches. Functional imaging studies in patients with tinnitus have revealed alterations in neuronal activity of central auditory pathways, probably resulting as a consequence of sensory deafferentation. However, nonauditory brain areas are also involved. These nonauditory brain areas might represent both an "awareness" network involved in the conscious perception of the tinnitus signal as well as areas related to a nontinnitus-specific distress network consisting of the anterior cingulate cortex, anterior insula, and amygdala. Moreover, memory mechanisms involving the hippocampus and the parahippocampal region may play a role in the persistence of the awareness of the phantom percept, as well as in the reinforcement of the associated distress. All of these networks represent potential targets for treatment via pharmacological treatment or noninvasive and invasive brain stimulation. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive method of applying electromagnetic fields to the brain that can induce alterations of neuronal activity that outlast the stimulation period. Single sessions of rTMS over the temporal or temporoparietal cortex have been successful in transiently reducing tinnitus perception. Repeated sessions of rTMS have resulted in tinnitus relief in a subgroup of patients, lasting from several days to several months. However, effect sizes of rTMS in the treatment of tinnitus are only moderate, and interindividual variability is high. Larger and longer lasting effects have been observed with direct electrical stimulation of the auditory cortex via implanted epidural electrodes. Transcranial direct current stimulation (tDCS) has also shown potential for the treatment of tinnitus. Both auditory and frontal tDCS have shown tinnitus reduction in a subgroup of patients. In spite of the promising results of the different brain stimulation approaches, further research is needed before these techniques can be recommended for routine clinical use.

摘要

耳鸣是一种常见病症,药物治疗、主动或被动声音增强以及认知行为疗法等传统治疗方法疗效有限。因此,迫切需要更有效的治疗方法。对耳鸣患者的功能成像研究显示,中枢听觉通路的神经元活动发生了改变,这可能是感觉传入阻滞的结果。然而,非听觉脑区也参与其中。这些非听觉脑区可能既代表了参与耳鸣信号有意识感知的“意识”网络,也代表了与由前扣带回皮质、前岛叶和杏仁核组成的非耳鸣特异性痛苦网络相关的区域。此外,涉及海马体和海马旁区域的记忆机制可能在幻听感知的持续存在以及相关痛苦的强化中发挥作用。所有这些网络都是通过药物治疗或非侵入性及侵入性脑刺激进行治疗的潜在靶点。重复经颅磁刺激(rTMS)是一种将电磁场应用于大脑的非侵入性方法,可诱导神经元活动的改变,且这种改变在刺激期过后仍持续存在。在颞叶或颞顶叶皮质进行单次rTMS治疗已成功短暂减轻耳鸣感知。多次rTMS治疗使一部分患者的耳鸣得到缓解,持续时间从几天到几个月不等。然而,rTMS治疗耳鸣的效应大小仅为中等,个体间差异较大。通过植入硬膜外电极直接电刺激听觉皮质观察到了更大且更持久的效果。经颅直流电刺激(tDCS)也显示出治疗耳鸣的潜力。听觉和额叶tDCS均在一部分患者中显示出耳鸣减轻。尽管不同的脑刺激方法取得了有前景的结果,但在这些技术可被推荐用于常规临床使用之前,还需要进一步研究。

相似文献

[1]
Tinnitus: therapeutic use of superficial brain stimulation.

Handb Clin Neurol. 2013

[2]
Strategies for enhancement of transcranial magnetic stimulation effects in tinnitus patients.

Int Tinnitus J. 2009

[3]
Controversy: Does repetitive transcranial magnetic stimulation/ transcranial direct current stimulation show efficacy in treating tinnitus patients?

Brain Stimul. 2008-7-1

[4]
Transcranial magnetic stimulation: a new diagnostic and therapeutic tool for tinnitus patients.

Int Tinnitus J. 2008

[5]
Efficacy of different protocols of transcranial magnetic stimulation for the treatment of tinnitus: Pooled analysis of two randomized controlled studies.

World J Biol Psychiatry. 2014-5

[6]
Repetitive transcranial magnetic stimulation improve tinnitus in normal hearing patients: a double-blind controlled, clinical and neuroimaging outcome study.

Eur J Neurol. 2009-7-9

[7]
Repetitive transcranial magnetic stimulation (rTMS): a new therapeutic approach in subjective tinnitus?

Neurophysiol Clin. 2006

[8]
Short-term effects of single repetitive TMS sessions on auditory evoked activity in patients with chronic tinnitus.

J Neurophysiol. 2010-6-30

[9]
Transcranial magnetic stimulation (TMS) for treatment of chronic tinnitus: clinical effects.

Prog Brain Res. 2007

[10]
rTMS for the treatment of tinnitus: the role of neuronavigation for coil positioning.

Neurophysiol Clin. 2009-4-1

引用本文的文献

[1]
Sequential Prefrontal and Temporoparietal Repetitive Transcranial Magnetic Stimulation (rTMS) for Treatment of Tinnitus With and Without Comorbid Depression: A Case Series and Systematic Review.

Front Neurol. 2022-5-19

[2]
What's the buzz? The neuroscience and the treatment of tinnitus.

Physiol Rev. 2021-10-1

[3]
RTMS parameters in tinnitus trials: a systematic review.

Sci Rep. 2019-8-21

[4]
Effect of Neuronal Excitability in Hippocampal CA1 Area on Auditory Pathway in a Rat Model of Tinnitus.

Chin Med J (Engl). 2018-8-20

[5]
A Pilot Study of Peripheral Muscle Magnetic Stimulation as Add-on Treatment to Repetitive Transcranial Magnetic Stimulation in Chronic Tinnitus.

Front Neurosci. 2018-2-20

[6]
Paired Associative Stimulation of the Temporal Cortex: Effects on the Auditory Steady-State Response.

Front Psychiatry. 2017-11-8

[7]
Bi-modal stimulation in the treatment of tinnitus: a study protocol for an exploratory trial to optimise stimulation parameters and patient subtyping.

BMJ Open. 2017-10-25

[8]
Does Tinnitus Depend on Time-of-Day? An Ecological Momentary Assessment Study with the "TrackYourTinnitus" Application.

Front Aging Neurosci. 2017-8-2

[9]
Repetitive transcranial magnetic stimulation and drugs for tinnitus.

Eur Arch Otorhinolaryngol. 2017-5

[10]
Functional Connectivity Substrates for tDCS Response in Minimally Conscious State Patients.

Front Cell Neurosci. 2016-11-3

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